On behalf of all the co-authors, I would like to thank Dr. Hari and Dr. Bagga for their inte­rest in our study. In the letter, they have pre­sented the results of their study, which confirm most of our findings too. Similarly, they have found that the co-administration of albumin and furosemide in patients with the NS can lead to an increase in sodium excretion and urine volume when compared with administra­tion of furosemide alone. [1],[2] It is accepted that the GFR has a strong rela­tionship with serum albumin level, as the se­rum albumin level (g/dL) is one of the six va­riables in the MDRD formula for estimating the GFR. [3] We have also mentioned that the difference between groups receiving furosemide alone and furosemide with albumin could not be explained solely by the increase in GFR in the group receiving albumin, and could suggest an improvement in furosemide's diuretic effects in addition. [2]

Since Hari et al found negative free water clearance and increased solute fluid clearance among their findings; they suggested that the increased natriuresis and diuresis occurred chiefly due to improved delivery of furose-mide to the tubules rather than intravascular volume expansion. [1] Of course, we believe that these two factors (improved drug delivery and increased intravascular volume) are not funda­mentally distinct and separate phenomena, since intravascular volume expansion leads to higher renal blood flow and probably higher GFR, which consequently can increase the de­livery of furosemide to the tubules and maxi­mize its influence.

Although some studies are against the syner-gistic effect of albumin and furosemide in increasing the diuresis, [4],[5],[6],[7] most of the recent studies are advocating their co-administration. [1],[2],[8] The studies which failed to find any poten-tiation effect of albumin infusion on the diu­retic efficacy of furosemide in patients with the NS may have some methodological errors (e.g. patient selection). For example, the study of Akcicek et al enrolled patients who were not resistant to diuretics, [4] which can justify the reason they failed to find a synergy between albumin and furosemide. Elwell et al conduc­ted a systematic review in 2003 in this regard, which concluded that the administration of albumin to enhance diuretic efficacy should be reserved for patients with severe hypoalbu-minemia. [8] We suggest that all the available studies should be critically appraised and included in a new meta-analysis to draw a final conclusion.